The present invention relates to a hernia implant, a method for its manufacture and its use in surgery.
Hernia is a frequently encountered illness. It generally involves a passage of organs or organ parts out of the natural body cavity through a preformed or acquired gap. Inguinal, umbilical and cicatricial hernias are the most frequently encountered external hernias, in which the hernial sac is always surrounded by peritoneum. The reasons for hernias occurring are in particular muscular or connective tissue weaknesses in conjunction with strains, slackening caused by age, congenital weakening of the abdominal wall or inadequate cicatrization following an abdominal incision (cicatricial hernia).
An effective treatment is possible in most cases by a surgical operation, where the content of the hernia is passed back from the hernial sac into the abdomen and the hernial orifice is sealed. The sealing of the hernial orifice generally takes place by means of a suture.
However, this surgical procedure suffers from the disadvantage that in up to 20% of cases a further hernia can occur, which is known as the hernial recidivation or recurrence.
Due to this unsatisfactory recurrence rate following conventional hernia operations, in modern hernia surgery use is being increasingly made of synthetic reinforcing materials for reconstructing the abdominal wall. An important part is played by nets of polyester, polypropylene and polytetrafluoroethylene.
Although the use of such nets has clearly led to a marked reduction in the recurrence rate, these implants give rise to problems as a result of possible infections, the formation of hard scar scales, displacements or fistula formations. Particularly in the hypogastric region, due to leg mobility, a supply with a very elastic implant and elastic scar formation is necessary for rapid healing and freedom from complaints on the part of the patient.
The problem of the invention is to make available a hernia implant for use during surgical operations, which overcomes the difficulties encountered with the prior art implants, which is easy and inexpensive to manufacture and which is easy to handle in standard surgical procedures.
This problem is solved by a hernia implant for use in surgery having a flexible fabric, which is formed from at least two substantially independently constructed textile fabric structures, which are firmly interconnected over the entire surface of the implant so as to form a composite structure. Such a composite structure offers a high initial implant strength.
Preferably, in the hernia implant according to the invention, substantially all the composite components are formed from monofilaments and preferably exclusively from monofilaments. The use of monofilaments in implant structures compared with multifilament yarns is characterized by a reduced infection susceptibility, because germs find no colonization spaces such as are encountered between single fibres.
Advantageously a monofilament can have a thickness of 10 to 500 xcexcm, particularly 100 to 150 xcexcm. According to an embodiment of the invention the monofilaments of the independent textile fabric structures essentially have the same thicknesses. According to another embodiment of the invention the monofilaments of the independent textile fabric structures can have different thicknesses.
According to the invention the fabric can be produced by a textile method, particularly knitting, weaving or braiding. Such procedures are known to the expert, so that a detailed description is not provided here. The invention gives preference to knitted fabrics.
Thus, in a preferred embodiment the hernia implant is formed from knitwear, particularly knit goods. This permits a simple, inexpensive manufacture according to known, proven procedures using conventional machines and tools.
Advantageously the individual textile fabric structures can be constructed in the form of net structures, particularly knitted net structures. Knitwear is characterized compared with other textile structures by a higher flexibility of the fabric, which is desirable for uses in medicine. In an embodiment the at least two nets can have substantially the same structure. In another preferred embodiment the at least two nets can have different structures. Differences in the structure can in particular be formed by different binding of the filamentary material in the textile fabric.
The openings or pores of the nets can have random polygonal or oval shapes. For example the net structure can be rhombic, latticed, honeycombed, circular or slot-shaped. Advantageously openings of at least one fabric structure preferably have a substantially hexagonal shape. A knitted net can e.g. have a honeycombed structure and hexagonal pores are surrounded by bridges formed from knitted monofilaments.
According to the invention the individual textile fabric structures can have a pore structure with pore sizes or opening sizes of 0.1 to 10 mm, particularly 0.5 to 5 mm. In an embodiment of the invention the pore sizes of the individual textile fabric structures can be substantially identical. In another preferred embodiment of the invention the pore sizes of the individual textile fabric structures can differ.
According to an embodiment of the invention the individual textile fabric structures can be produced according to the same procedure. According to a further embodiment of the invention the individual textile fabric structures can be produced according to different binding procedures. For example, in a preferred embodiment, one textile fabric is formed by knitting in accordance with the satin or atlas 2-row binding method. In another preferred embodiment one textile fabric can be formed by knitting according to the tulle fillet binding method. The production of the individual fabric structures with different binding methods permits in simple manner the formation of different pore shapes and sizes.
Advantageously the textile fabric structures can be interconnected by textile methods. Particular preference is given according to the invention to the textile fabric structures being interconnected by knitting. In this way fabric structures produced by knitting can be combined to form a composite in simple manner using the same machines and procedures.
According to the invention the textile fabric structures, particularly net structures, can be so mutually arranged that their structure pores, particularly openings do not align and in particular roughly overlap by half. The hernia implant according to the invention can be characterized in that the textile fabric structures, particularly net structures, overlap in both dimensions of the net planes. In this way, for the same weight per unit area, a fabric which is tighter with respect to the passage of substances such as body fluids, cells or microorganisms is obtained than when the net pores are oriented in aligned manner. In addition, a close-mesh textile structure facilitates the growing of the hernia implant into the body and consequently aids rapid healing.
In the case of knitting, such net structures can be produced in that two independent fabrics are constructed on mutually laterally displaced needles. In an embodiment fabrics can be produced with different mesh sizes. In this way e.g. in the internal pore size of a coarser meshed net can be located several meshes of a finer meshed net. With particular advantage such overlapping structures can be produced by the simultaneous knitting with different knitting constructions or bonds.
The hernia implant according to the invention can advantageously be characterized in that it is at least partly absorbable in vivo. The decomposition or degradation of a bioabsorbable polymer takes place by metabolic processes in the body of an animal or human. Body and tissue fluids participate in the reaction. As a result of hydrolysis the polymer chain is split into smaller and more easily soluble fragments. The fragments are further degraded, optionally accompanied by the participation of enzymatic processes. The degradation products are transported away by the metabolic system and are eliminated from the organism in the same way as other metabolic waste products. It is important for a good compatibility of the absorbable implant material by the patient, that during the degradation process no harmful metabolites are formed or concentrated.
In the case of the hernia implant according to the invention at least one of the textile fabric structures, particularly one having hexagonal openings, can be substantially formed from non-absorbable material and at least one further textile fabric structure can be substantially formed from absorbable material. The invention gives preference to an embodiment in which two independently formed fabric structures are provided, whereof one is formed from non-absorbable material and the other from absorbable material. It is also preferable according to the invention for the fabric structure of non-absorbable material to have hexagonal openings.
Advantageously absorbable filamentary material is used for joining the textile fabric structures. According to the invention the hernia implant can contain absorbable and non-absorbable material in a ratio of 90:10 to 10:90, particularly 30:70 to 70:30 and preferably 50:50.
Within 8 to 12 weeks following the introduction of the implant according to the invention, as a result of the degradation reactions on the absorbable material in the body of the patient there is a hernia implant strength loss. Due to biochemical degradation, there is chain splitting and weight loss with respect to resorbable components in the polymer filamentary material. This leads to a progressive deterioration of mechanical characteristics such as e.g. the strength and flexural rigidity. The implanted fabric becomes increasingly elastic, can better adapt to local circumstances in the abdomen and can perform movements made by the patient.
Advantageously in the hernia implant according to the invention the absorbable component is completely degraded in vivo after 6 to 50 weeks, particularly 8 to 12 weeks.
Advantageously as a result of the degradation of the absorbable material in vivo, it is possible to increase the pore size of the hernia implant. In this way it is possible to at least compensate a stiffening by the growing in of body cells by a partial degradation of the composite structure. Over a period of time there can be a cicatrization of the hernia implant with the abdominal wall. The resulting union of abdominal wall and implant contributes to the stabilization of the said wall and consequently ensures the success of the treatment.
With advancing absorbable material degradation an implant weight loss occurs, which is revealed in an increasingly open-cell nature of the structure. Following complete degradation of the absorbable component a fabric structure of non-absorbable material is left behind. Preferably the fabric structure of non-absorbable material is formed with a hexagonal pore structure. A hexagonal structure is particularly advantageous for a hernia implant remaining in vivo. In this way through the choice of the textile construction of the individual fabric structures of the hernia implant union of non-absorbable and absorbable material, it is possible to obtain an optimum structure for growing in and adaptation to physiological circumstances of the implant part remaining permanently in the patient""s body. Preferably the components of the implant composite structure are chosen in such a way that following resorption of the biodegradable material a hernia implant remains in the body, whose mechanical characteristics are adapted to the natural characteristics of the abdominal wall.
In the present invention an embodiment is particularly advantageous where a fabric structure of non-absorbable material and at least one further fabric structure of absorbable material are formed into a hernia implant composite structure. A further advantage of the invention is the use of monofilaments for forming the textile fabric structures. Compared with the individual filaments in a multifilament, such as are known from the prior art, a monofilament has a greater thickness. Thicker monofilaments have a higher flexural rigidity, which has an effect on the handling properties of a resulting textile fabric. For a large-area, creaseless and stress-free insertion of flat hernia implants in the abdomen of a patient, reliable handling, i.e. a certain rigidity and strength of the implant, in addition to flexibility is desired. By the use of absorbable monofilaments in an implant composite structure according to the invention such a desired stability is achieved.
During the biochemical resorption of the degradable components the mechanical strength and rigidity of the hernia implant continuously decrease, i.e. the implant becomes more flexible, so that the patient is less stressed by the implant. Following the degradation of the absorbable material fraction, a flexible net with only a small amount of foreign material remains in the patient""s body.
In a special embodiment the monofilament of absorbable material can be thicker than the monofilament of non-absorbable materials. According to the invention preference is given to an absorbable monofilament with a thickness of 100 to 250 xcexcm. According to the invention, preference is given to a non-absorbable monofilament with a thickness of 100 to 250 xcexcm. This makes it possible to minimize the foreign material quantity left behind following absorption of the biodegradable material. The absorbable and non-absorbable monofilaments can have the same or different thicknesses.
According to the invention the non-absorbable material can have a weight per unit area of up to 50 g/m, particularly up to 40 g/m. The non-absorbable material can have a strength of 16 to 50 N/cm. The hernia implant according to the invention can have a bursting pressure of 100 to 300 kPa. The hernia implant according to the invention can have a bursting elongation or extension of 20 to 50 mm.
Advantageously the hernia implant according to the invention is characterized in that its extensibility, measured in the longitudinal, transverse and diagonal directions, differs by no more than 50% in each case and in particular have substantially identical values. The hernia implant according to the invention can also be characterized in that its tearing or tensile strength, measured in the longitudinal, transverse and diagonal directions, in each case differ by no more than 50% and in particular have substantially identical values.
In the case of the hernia implant according to the invention the non-absorbable material can be selected from the group comprising polypropylene, polytetrafluoroethylene, polytetrafluoroethylene-hexafluoropropylene copolymer, polyethylene terephthalate, polybutylene terephthalate, as well as their mixtures, copolymers and terpolymers. In a preferred embodiment of the invention the absorbable material is formed from monofilament polylactide fibres. In another preferred embodiment of the invention the absorbable material can be formed from monofilament fibres of polylactide-glycolide copolymer.
In the case of the implant according to the invention the absorbable material can be selected from the group comprising polyglycolide, polylactide, polydioxanone, polyhydroxybutyric acid, polycaprolactone, polytrimethylene carbonate, polytetramethylene carbonate, as well as their mixtures, copolymers and terpolymers. In a preferred embodiment of the invention the non-absorbable material is formed from monofilament polypropylene fibres.
According to a further development the hernia implant can contain an antimicrobiotic agent, such as e.g. an antibiotic. The administration of antibiotics more particularly serves to prevent infections. For prophylaxis and therapy with antibiotics use is made in the surgery field of e.g. cephalosporins such as cephazolin and cephamandol, netilmycin, penicillins such as oxacillin or mezlocillin, tetracycline, metronidazole or aminoglycosides such as gentamycin or neomycin, as well as e.g. rifampicin. In accordance with the given requirements, the experts can select one or more appropriate active agents. The hernia implant can also contain growth factors.
The present invention also relates to a method for the manufacture of a hernia implant for use in surgery comprising the formation of at least two independent textile fabric structures and the joining together of these textile fabric structures over their entire surface area in order to form a composite structure in the form of a flexible fabric. Preferably the textile fabric structures are in the form of knitwear and are particularly produced by knitting. The textile fabric structures can, according to the invention, be joined by textile procedures, particularly by knitting during their joint manufacture.
For use in surgery, the hernia implant modified according to the invention can be appropriately sterilized. An appropriate sterilization process can be constituted by conventional physical or chemical methods for inactivating microorganisms or a combination thereof. One possible sterilization process comprises treatment with ionizing radiation such as e.g. irradiation with gamma or beta rays in the range 0.1 to 10 mrad, particularly 0.8 to 2.5 mrad.
The invention also relates to the use of a hernia implant in surgery, particularly for the treatment of wall defects in body cavities, particularly abdominal wall defects.
To this end the hernia implant material modified according to the invention can be cut to a desired size and shape. Advantageously the surgical hernia implant according to the invention can be suitably packed cut to appropriate dimensions and ready for use. In practice, preferred dimensions of 15xc3x9730 cm or 30xc3x9730 cm are used.